DENTISTS in North Yorkshire may be forced to pay back hundreds of thousands of pounds after failing to meet tough targets set in their new NHS contracts.

Two-thirds of dentists in the region have fallen below a national cut-off point for the number of units of dental activity (UDA) they rack up by treating people's teeth.

That means some of the money they were paid by North Yorkshire and York Primary Care Trust (PCT) when the widely-criticised General Dental Service Contracts came into force two years ago could be clawed back.

It has sparked fears more dentists will retire or go private - leaving patients already struggling to find affordable dental care with yet another toothache.

Under the contracts - worth an average of £80,000 a year - NHS dentists should deliver at least 96 per cent of their agreed UDA, but figures obtained under the Freedom of Information Act by private dental plan administrator DPAS have revealed 66 per cent of North Yorkshire dentists could not reach this target.

Almost one in three of those fell more than 25 per cent below their contractual commitments in 2006-07, the first year of the new arrangements, with the British Dental Association (BDA) saying the UDA system is making it virtually impossible for dentists to cope.

The PCT says it has yet to decide whether to claw back any cash and that, if it does, it will be poured back into dental services. But some dentists are concerned it may be used to help plug the organisation's £35 million deficit instead.

"Whether a patient requires ten fillings or one, it means the same number of units for their dentist and that's why there are issues about this crude, target-driven system," said a BDA spokeswoman.

"Preventative work, such as advising people about dental care, doesn't count towards their UDA and neither does the goodwill a practice has built up, the quality of care and the patient's experience. Many NHS dentists feel frustrated and pressurised and are considering their futures.

"The result will be that patients lose out. Dentists want to help them, but this unfair system is working against them." Dr Rob Grabowski, who runs the Crystal Clear Dental Spa, in York, is one of those who has switched from the NHS to private dental care.

He said: "Many dentists are living with the constant threat of clawback as each year they struggle to meet the unrealistic targets placed upon them by the contracts.

"We understand patients brought up with NHS dental care will always struggle with the concept of paying for a service which should be free, but since converting from the NHS, we've been able to offer patients a vastly-improved service and level of care."

Dentists who have just missed the 96 per cent threshold may be able to make up the shortfall in subsequent years, but DPAS chairman Quentin Skinner - who collated the research - said: "They will have to do more work for less money as their revenue is reduced, as well as coping with the pressure of this year's UDA requirements.

"Many will find themselves in a position where their NHS earnings are forced in a one-way-only direction - downwards."


Contracts system is bizarre'

"BIZARRE and unworkable" - that's the damning description of the contracts system by a York NHS dentist with 30 years' experience.

Dr Peter Mikola, from Copmanthorpe Dental Practice, finds himself at the opposite end of the spectrum from the dentists struggling to reach their UDA quota - the points he is allocated are actually leaving him struggling to treat his current patients.

And he has added his voice to the contract criticism, saying: "It's a nightmare - it's not satisfactory or beneficial and doesn't make life easy for either dentists or patients, "I've had to reschedule some patients' appointments into the next financial year because I haven't got enough units left to treat them in this one, and if you go over your UDA level, you're basically working for nothing.

"It's a more bizarre system than the old one, where there were no caps or ceilings - it's based on bureaucracy and chasing targets all the time, not clinical necessity.

"There might be extenuating circumstances why some dentists aren't reaching their targets, but if there's no good reason why they haven't done the work they're contracted to do, the money they've been paid should be redistributed within dentistry.

"What it should not be used to do is to offset the considerable debt accrued by the PCT.

"I am concerned about it simply being dropped into a black hole."


Dental activity is monitored'

A SPOKESWOMAN for North Yorkshire and York Primary Care Trust said: "We work very closely with our dental colleagues to monitor levels of dental activity in relation to agreed NHS contracts.

"Contracts are regularly reviewed with dentists to determine whether contractual levels of service meet demand. In some cases, the PCT will ask dental practices who have under performed their contractual obligations to refund the difference for reinvestment in future dental services.

"The PCT measures levels of dental activity against national guidance set at a 96 per cent threshold in order to identify practices where contractual adjustments need to be made.

"We are unable at this time to determine whether any contractual levels of service will require adjusting."